Thad E. Abrams, MD, MS; Mary Vaughan-Sarrazin, PhD; Vincent S. Fan, MD, MPH; Peter J. Kaboli, MD, MS
Abrams TE, Vaughan-Sarrazin M, Fan VS, Kaboli PJ. Geographic Isolation and the Risk for Chronic Obstructive Pulmonary Disease–Related Mortality: A Cohort Study. Ann Intern Med. 2011;155:80-86. doi: 10.7326/0003-4819-155-2-201107190-00003
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Published: Ann Intern Med. 2011;155(2):80-86.
Little is known about the possible differences in outcomes between patients with chronic obstructive pulmonary disease (COPD) who live in rural areas and those who live in urban areas of the United States.
To determine whether COPD-related mortality is higher in persons living in rural areas, and to assess whether hospital characteristics influence any observed associations.
Retrospective cohort study.
129 acute care Veterans Affairs hospitals.
Hospitalized patients with a COPD exacerbation.
Patient rurality (primary exposure); 30-day mortality (primary outcome); and hospital volume and hospital rurality, defined as the mean proportion of hospital admissions coming from rural areas (secondary exposures).
18 809 patients (71% of the study population) lived in urban areas, 5671 (21%) in rural areas, and 1919 (7%) in isolated rural areas. Mortality was increased in patients living in isolated rural areas compared with urban areas (5.0% vs. 3.8%; P = 0.002). The increase in mortality associated with living in an isolated rural area persisted after adjustment for patient characteristics and hospital rurality and volume (odds ratio [OR], 1.42 [95% CI, 1.07 to 1.89]; P = 0.016). Adjusted mortality did not seem to be higher in patients living in nonisolated rural areas (OR, 1.09 [CI, 0.90 to 1.32]; P = 0.47). Results were unchanged in analyses assessing the influence of an omitted confounder on estimates.
The study population was limited to mostly male inpatients who were veterans. Results were based on administrative data.
Patients with COPD living in isolated rural areas of the United States seem to be at greater risk for COPD exacerbation–related mortality than those living in urban areas, independent of hospital rurality and volume. Mortality was not increased for patients living in nonisolated rural areas.
U.S. Department of Veterans Affairs.
Patients who reside in rural areas probably have worse health outcomes because of distance to care.
In this analysis of mortality among veterans hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD), study participants living in isolated rural areas were at higher risk for death than those living in nonisolated rural and urban areas.
The study population was mostly male, and the findings were based on administrative rather than clinical data.
Patients with COPD who live in isolated rural areas of the United States seem to be at greater risk for COPD exacerbation–related mortality. These findings could be used to investigate whether providing an appropriate workforce and other support resources to those areas would reduce the difference in mortality.
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Chronic Obstructive Airway Disease, Hospital Medicine, Pulmonary/Critical Care.
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